RF-TB-2.21.pdf
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1. National TH control Programme
No need to change integrated nature of NTP,
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keepino in
view of the modest success already achieved and the rising
acceptance of the fact that there is no alternative to
integration. Instead, both short and long term steps
should be taken to expand areas of integration & strengthen
integrated activities, starting from the dist. level
bee-use at rresent integration is functional, largerly
at the periphery.
2. Care final .ino (cF)
:
After reviewinn the contribution made by Multi Purpose
Workers (MfW) at the Primary health centres (PHC) level,
d1r
specially In case finding, the croup recommended that the
initial rroor-mre or male MP:;f undertaking this activity
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should be continued. Nov,-ver, it was felt that strengthen
ing the laboratory components nt the Flic level is essential
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to make this con ribution more meaninful. Therefore,
immediate steps are needed to take up the training activity
for rural La}- Technicians (LT-s) in order to strengthen
the laboratory servies at Pi’C level.
The group unanimously recommended that the
case finding
as a whole needs to bo stepped up.
However the strategy
for urban and me‘-erpol.i t-n cities have to be different
from the rural areas. Within cities the focus has to be
on slums. bustis and new settlements in outlying areas.
In order that the CF & later case holding in the cities
to be successful, it is importive that all the General
Hospitls, dispensaries & other institutions work in an
organised & co-ordinatelv manner, so that the T13 services
ran be rendered efficiently. In addition, voluntary
.oroanisations can be organised to devote particular attention
to the slums, bastis and out lyinc settlements as a part of
co-ordinatinr the Programme.
It was mentioned that the
Govt. has. a scheme of establishing community health centres
(GHC-r.) with ado-ju-ito staff .9 other facilities. These
CHO' could assist in augmenting CF with the use of x-rays
and should bo more conveniently situated bet- een the OTCs
A PHCs.
.However, till these are tn place, GIICs for stepping
up F cannot- bp the matter 6f any recommend ?tion.
2
3. Cose Holding (CH) :
The crucial im*ortance of adegu ito -vailability of AntiTB drugs for making tratem-'-nt & CH '•eaningful> it was
recommended that stops should bo tsken to ensure adequate
suprlies of drugs not O’ly in DTCs but also in the PHCs.
The number of drug recimens in the National Chamothare tty
policy was reduced to a minimum in order to avoid confusion.
The croup recommended for adoption of the following drug
reoimen.
Conventional Thearapy (when SCC is not introduced).
2 SHT/10 IIT ~ for SP +ve
seriously ill patient
(S-P.75 cm,
rm. 11-300 mo, T-150 mg daily)
12 HT for smear lien - but rndi olooically Pos.
If the pt cannot tolerate T then 'T* to be replaced by ’E*
SCC
1.
2 EHRZ/6 HT
2EHRZ/4H2x72
2.
(Bi weekly)
(H-600 - 700 mg with Vlt b
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10 mo, R-600 mg)
weekly in contmation phase
(If the nt -annot tolerate
i -p •
bo replaced by 'E1)
(H-TNH, S-Sheptomycin, T-Tbincotazono, R-Rifampicin,
Z-Pyrazinamide, E-Etharnbutol) •
'Hie group underlined the fact that the- intention is to
introduce PCC all over the country, as soon as possible.
The conventional regimen will be used till such time the
GCC covers the entire country.
It was further recommended that all SP + cases could,..fee
riven E-CC.
reqimen.
The SP Neg pts should he given conventional
Case boldine capacity needs considerable strengthening,
"or this purnos° opgraticnal studies are needed, specially
focimsino on druo d i s t^ Ll.uhion " taking drug defaulter
action.
It was also Cel’ th it Ln tb.ir area the NGO’s
can play an important rn]c.
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4.
Management of the programme :
The importance or supervision f.: Monitorinc was stressed.
It was pointed out that these two have tn be done at all
levels. At present, programme - monitoring is being
done? by Nti, Bangalore from the quarterly reports received
from the states. This could be continued.
But in
addition, states have to take up this responsibility,
leading to the establishment of strong monitoring cell
in each state,-which can be a part of Monitoring section
for all the Health Programmes. It war recommended that
NTI should explore the need to train staff in supervision
as well as in monitoring. To strengthen central monitoring
and supervision. Regional IJnalth Offices (RHOs) may be
involved to improve supervision & monitoring at regional
level.
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Tra in inn
The traininn activittns at thn NTI, Ran'-’alore must be
continued and modified tn th'" 1 iglit of th •• various
recommendations boi.no nude. Ho- ever, t”" reduce the training
load of a big country like India, it was strongly
r-commend■ d that sFat° TB.
take up the re-training
6.
Demonstration centre, should
ro-orientation of their personnel.
Health Education (HE)
The importance of Health Education was realised by every
one.
It was also agreed that: the responsibility of HE
at the district level has to he co-ordinated and discharged
in collaboration with H.E bureau, village officials,
voluntary organisation,
etc.
Sc'nool Health Education authority
US a-’dod Health wrojoct was undertaken by TB
Ass&cQ3.toon of India, recently in 250 dist. in the
country.
Based on this experience it was recommended that
pattern of work ado-tod therein n^ndr some modification,
The remaining dist. in tbf' country can be implementiq: in
collaboration with 'he agencies concerned, according to
the modified pattern,
In thir- connection. better use of
electronic media was sucoest.cci.
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7. Repeat survey : Noting that the available data on
prevalence and incidence in the country are quite old
it was stressed that the data has become irrelevant.
The group realised that the need for up-to-date data
will be felt more strongly as time passes. The possib
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ility of conducting a nation wide survey of simpler
kind is being explored by some research institutions
& NTI, Bangalore. When the methodology become suitable,
the question of repeating nation wide survey can be
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re-examined.
gained due
A. Target setting : In view of the experience
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to targets especially the C.F since 1952, the group
strongly recommended that the practice of target setting
should be continued with some modification, if it
becomes necessarv.
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9. Voluntary Organisation (VOS) : It was strongly felt
that the time had come for VOS to become partners with
the Gov::, in running the NTP successfully.
Besides
Health Education, they could greatly help in C.F.,
especial’y in the city slums and CH by establishing the
Drug Distribution Centres, from where the patients could
collect drugs at the most convenient time. It was also
recognised that besides the TB Association of India jTAl)
and its affiliate state organisations, there are other
voluntary agencies v/hich are doing anti TB work. The
responsibility for bringing the other small VOS under the
umbrella of NGOs should be taken by TAI. The processes
of establishing close comnunlcation., collaboration and
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co-ordination with NGOs should be thken up as soon as
possible.
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